Plus what men can do to avoid premature death.
by Michael T. Murray, N.D.
Research has identified a group of
Americans who develop common, deadly
diseases more often and die younger than
others. Yet neither the government nor the group
itself is up in arms about it, says Robert Alt, M.D., a
Wisconsin internist who also studies men’s health.
“The reaction has been near silence.”
That group, of course, is American males, who
lead women in 12 of the 15 top causes of death in the
U.S.—all except stroke and hypertensive kidney disease,
which both sexes develop equally, and
Alzheimer’s disease, which strikes women more
often, mainly because they live longer. Men now die
on average about 5.4 years earlier than women. In
1920, when records were first kept, the difference
was just 2 years.
A sliver of the gender gap may stem from biological
differences. But most of the gap, many
experts say, stems from inattention—from society
and men themselves.
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THE GROWING GAP
Both men and women are living longer today than in the
early years of the 20th century. But women live longer,
and the gap has been growing—from just 2 years in 1920
to 5.4 years today—mainly because men don't take the
necessary health-protective steps. If men and women
equally took those steps, it's likely that the gap would virtually
disappear, and both sexes could expect to live
nearly 100 years.
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While the medical profession and the federal
government have paid special attention to women’s health for the past two decades or so, there has been no comparable focus on men’s unique health needs,
despite some obvious gaps in understanding key
male issues. For example, while the number of new
cases of prostate cancer in men nearly equals the
number of new breast-cancer cases in women, the
government spends twice as much on breast-cancer
research. There’s no government Office of Men’s
Health to match the similarly named office for
women. (More than 100 members of Congress are
now sponsoring a bill to establish a men’s office.) Nor
is there a medical specialty for men similar to gynecology
for women. (A gynecologist is often a
woman’s primary doctor, but a urologist—the closest
thing to a male specialist—would never be a man’s.)
Perhaps most important, women are far more
likely than men to get routine preventive care, in
part because certain issues tend to draw women
automatically into the health-care system. “Women
tend to see doctors regularly, to deal with issues like
birth control and pregnancy, and to get screening
tests like Pap smears and mammograms,” says
David Gremillion, M.D., a North Carolina physician
who’s lobbying the federal government to focus
more on men’s health. “For men, attendance at the
doctor’s office isn’t seen as mandatory.”
Of course, men contribute to that attitude.
“Many men are terrible patients, who seem constitutionally
opposed to thinking about their own
health,” says Dr. Alt. For example, a recent national
survey found that men see doctors far less often than
women do, partly because many of them don’t even
have one.
Why? Perhaps it’s as Andrew Kimbrell, a cofounder
of the Men’s Health Network, a Washington, D.C.
advocacy group, once wrote: “In their 20s, men are too
strong to see a doctor. In their 30s, they’re too busy, and
in their 40s, they’re too scared.”
And when men do see a doctor, they give up on
treatment plans and discontinue medications
sooner than women do. Further, they’re less likely to
follow through on common health advice. In
particular, they drink and smoke more than women do and are less likely to wear safety belts or limit their exposure to sunlight.
While the government and the medical profession
need to focus more on men’s health, there are steps
that men should take, too. The table lists the
tests and shots that can reduce the risk of deadly diseases
in men. (Nearly all of those steps can protect
women, too.) The strategies described below may help
some men overcome the barriers erected by society
and by male attitudes.
REALMEN GET SICK
The images of male heroes in the movies illustrate the
problem. On screen, they’re indestructible, surviving
numerous savage assaults without getting seriously hurt,
notes Will Courtenay, Ph.D., editor of the recently created
International Journal of Men’s Health and a psychiatry
lecturer at Harvard Medical School. But in real life, John
Wayne developed lung cancer, stomach cancer, and heart
disease, all caused at least in part by smoking. Ian
Fleming, creator of James Bond, died from complications
of a chest cold after ignoring his doctor’s orders to rest.
“Men tend to see themselves as invulnerable and
impervious to pain,” says Dr. Courtenay. “But that attitude
increases the risk, since you need to first admit that
you have weaknesses before you can take steps to prevent
disease. That’s hard for anybody, but especially men,
who grow up thinking that they have to tough it out.”
Men’s stoic attitude may further harm health by
magnifying the effects of stress. A recent study found
that men are more likely than women to get sick after
stressful events, such as violence, divorce, death in
the family, or bankruptcy. One reason for men’s susceptibility: They’re less likely to talk about the trauma.
Fortunately, our society now increasingly
encourages men to acknowledge and show their
weaknesses. Think of the New York City firefighters
who, since the collapse of the World Trade Center,
haven’t tried to hide their emotions. “Let them be
your role models, not John Wayne,” says Dr.
Courtenay.
A MAN’S PERSPECTIVE
While men may need to shed the tough-guy image,
other familiar male attitudes can be harnessed to help
them take control of their health:
- Boost performance. To work effectively, play hard,
and maintain a good sex life, a man (or woman) needs
a well-functioning body.
- Think maintenance. Sensible people don’t let their
car go without regularly changing the oil or fixing
squeaky brakes. The body needs regular maintenance,
too. And small problems must be addressed before
they turn serious.
- Be the expert. Learn how the body works, particularly
the heart and circulatory system, the urinary and
reproductive systems, and the digestive tract. That
can enhance your sense of control when talking with
the doctor. Knowledge and confidence may also
motivate patients to take better care of themselves.
Research shows that those who educate themselves
about their health and participate actively in their
health care tend to have better outcomes than passive
patients.
- Take charge. Some men can start taking charge by
breaking the habit of letting their wives make their
appointments—or at least by sharing in the decision
and then showing up for the appointment. But if letting
your wife handle the arrangements works for you,
don’t mess with success.
- Be a role model. Men who won’t see the doctor for
their own sake should think of the younger males in
their life. “I’ve had older patients agree to
colonoscopy—provided their middle-aged son did,
too,” says Dr. Gremillion.
- Find a coach. A doctor, like a coach or trainer, may
push patients to work at good health practices harder
than they would on their own. But that’s often what it
takes to improve.
THE RELUCTANT PATIENT
A March 2000 survey from The Commonwealth
Fund, involving some 1,500 men and 2,850 women,
revealed just how far men lag behind women in navigating
the health-care system. Here are some pointers
on how to overcome the most notable shortcomings:
- Find a doctor who’s easy to talk to. One-third of
men don’t even have a regular doctor, nearly twice
the rate in women. When seeking recommendations
about a new doctor, ask whether he or she is easy to
talk to. Consider looking elsewhere if communication
seems difficult during the initial visit.
- Don’t be shy. Women are far more open with their
doctors than men are, especially about urinary,
sexual, and emotional health. Dodging emotional
problems can be especially dangerous for men: While
women report depression slightly more often, men
are more than four times as likely to commit suicide.
To improve communications, patients could write
down or rehearse what they want to say beforehand,
or just hand their doctor a list of problems. And they
could ask someone to accompany them to the
doctor’s office to help express their concerns.
- Get checkups. Men are far less likely to have regular
checkups than women. But such exams are at least as
important for men, especially in middle age, when
deadly chronic diseases usually emerge and are most
treatable.
- Know the warning signs. Men often ignore those
warnings or delay seeing a doctor until a crisis arises.
The first step toward overcoming that tendency:
Learn the early signs of the most common and serious
medical conditions by consulting the table.
SUMMING UP
Men die younger than women, partly because of
gaps in the understanding of men’s health issues, but
mainly because they don’t get the preventive health
care that they should. To find the motivation to get
that care, men need to shed their stoicism and sense
of invulnerability. It may also help to view health in
familiar male terms: boosting performance, getting
regular maintenance, becoming an expert and a role
model, and regarding doctors as coaches. Those
shifts may help men take the essential steps: finding a
doctor they can talk to, seeing that doctor regularly,
and following through on the advice they receive.
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